Cited by 739Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsNeurological Disease Mechanisms and Treatments

Impact of multiple pathologies on the threshold for clinically overt dementia

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Kapasi, Alifiya, DeCarli, Charles, Schneider, Julie A.·2017·Acta Neuropathologica

Abstract

Longitudinal clinical-pathological studies have increasingly recognized the importance of mixed pathologies (the coexistence of one or more neurodegenerative and cerebrovascular disease pathologies) as important factors in the development of Alzheimer's disease (AD) and other forms of dementia. Older persons with AD pathology, often have concomitant cerebrovascular disease pathologies (macroinfarcts, microinfarcts, atherosclerosis, arteriolosclerosis, cerebral amyloid angiopathy) as well as other concomitant neurodegenerative disease pathologies (Lewy bodies, TDP-43, hippocampal sclerosis). These additional pathologies lower the threshold for clinical diagnosis of AD. Many of these findings from pathologic studies, especially for CVD, have been confirmed using sophisticated neuroimaging technologies. In vivo biomarker studies are necessary to provide an understanding of specific pathologic contributions and time course relationships along the spectrum of accumulating pathologies. In this review, we provide a clinical-pathological perspective on the role of multiple brain pathologies in dementia followed by a review of the available clinical and biomarker data on some of the mixed pathologies.

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Crossref · 10.1007/s00401-017-1717-7

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  • Research has shown that 15% to 30% of those diagnosed with Alzheimer's dementia during life do not have the brain changes of Alzheimer's disease but instead have brain changes of another cause of dementia.

    “research has shown that 15% to 30% of those diagnosed with Alzheimer's dementia during life do not have the brain changes of Alzheimer's disease but instead have the brain changes of another cause of dementia”

    From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [21]

    In “Mixed Pathologies: Update from the Religious Orders Study and Rush Memory and Aging Project” (page unavailable), the paper says that 85% of older people clinically diagnosed with probable Alzheimer’s disease had a pathological diagnosis of Alzheimer’s disease, implying 15% did not. It also says other vascular and degenerative pathologies were very common among those without that diagnosis. It does not establish the claimed upper figure of 30% or show that every person without Alzheimer’s pathology had pathology of another cause of dementia. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • In one autopsy study of 447 older people believed to have Alzheimer's dementia when they died, only 3% had the brain changes of Alzheimer's disease alone.

    “One autopsy study showed that of 447 older people who were believed to have Alzheimer's dementia when they died, only 3% had the brain changes of Alzheimer's disease alone”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [21]

    The section “Mixed Pathologies: Update from the Religious Orders Study and Rush Memory and Aging Project” (page unavailable) reports autopsy data and says that over 95% of people clinically diagnosed with probable Alzheimer’s disease had mixed pathologies. That supports the point that Alzheimer’s pathology alone was uncommon, but the available text does not establish the claimed subgroup of 447 people or the exact 3% figure. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • In that autopsy study, 15% had the brain changes of an entirely different cause of dementia.

    “while 15% had the brain changes of an entirely different cause of dementia, and 82% had the brain changes of Alzheimer's disease plus at least one other cause of dementia.”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [21]

    In “Mixed Pathologies: Update from the Religious Orders Study and Rush Memory and Aging Project” (page unavailable), the paper reports that 85% of people clinically diagnosed with probable Alzheimer’s had an Alzheimer’s pathologic diagnosis—leaving about 15% without one. It says other vascular and degenerative pathologies were common in that group, but does not establish that all 15% had brain changes attributable to an entirely different cause of dementia. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • In that autopsy study, 82% had the brain changes of Alzheimer's disease plus at least one other cause of dementia.

    “while 15% had the brain changes of an entirely different cause of dementia, and 82% had the brain changes of Alzheimer's disease plus at least one other cause of dementia.”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [21]

    The section “Mixed Pathologies: Update from the Religious Orders Study and Rush Memory and Aging Project” (page unavailable) reports autopsy data in which 85% of people clinically diagnosed with probable Alzheimer’s had AD pathology and over 95% had mixed pathologies. This supports the general point that AD commonly co-occurred with other pathology, but the text does not give the claimed 82% specifically for AD plus at least one other pathology. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • Prevalence estimates of dementia due to Alzheimer's disease based on Alzheimer's brain changes as well as overt clinical dementia symptoms are likely to be lower than the 6.9 million figure reported.

    “Prevalence estimates of dementia due to Alzheimer's disease based on Alzheimer's brain changes, as well as overt clinical dementia symptoms, are likely to be lower than the 6.9 million figure reported here.”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [21]

    The ROS/MAP update (page unavailable) reports that AD pathology was confirmed in 85% of older people clinically diagnosed with probable AD, supporting the distinction between a clinical diagnosis and one requiring AD brain changes. It does not assess the 6.9 million estimate or establish how much lower a corresponding prevalence estimate would be. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

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Authors
Kapasi, A., DeCarli, C., & Schneider, J. A.
Affiliations
  • Rush University Medical Center (US)
  • University of California, Davis (US)
Corresponding author
Schneider, Julie A.
Venue
Acta Neuropathologica
Published
2017-05-09
Volume
134
Issue
2
Pages
171-186
ISSN
  • 0001-6322 (ISSN-L)
  • 1432-0533
OpenAlex
W2612655633
Cited by
739
References
158
Citations by year
2026: 112 · 2025: 93 · 2024: 100 · 2023: 80 · 2022: 88 · 2021: 86 · 2020: 73 · 2019: 61 · 2018: 35 · 2017: 9 · 2014: 1
FWCI
7.40
Type
journal article
Language
en
Open access
Locations
  • Acta Neuropathologica (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institute on Aging (R01AG017917, P30AG010129, R01AG042210, RF1AG022018, R01AG015819, P30AG010161, R01AG034374, R01AG022018)
  • National Institute of Neurological Disorders and Stroke (UH3NS100599, UH2NS100599, UF1NS100599)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
Keywords
Alzheimer's disease, dementia, cerebrovascular disease, neurodegenerative diseases, cerebral amyloid angiopathy, microinfarcts, atherosclerosis, arteriolosclerosis, Lewy bodies, TDP-43, hippocampal sclerosis, in vivo biomarkers, neuroimaging
MeSH terms
Alzheimer Disease, Cerebrovascular Disorders, Cognition Disorders, Humans, Longitudinal Studies, Cohort Studies, Neuroimaging

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